Comment / Data key to Carter success

The final Carter report is imminent. By the time you read this, it may even have been published. However, it is already close to the top of many finance practitioners’ agendas. This is not surprising given we have already seen a preliminary report, supported by various conference presentations. And there has been substantial media coverage both about what Lord Carter and his team have already said and speculation about what they plan to say in the final report.

January saw separate stories about Carter’s ‘new’ adjusted treatment index (ATI) being based on discredited data, while the month closed with leaks of apparent plans to cap hospital management costs and to push much wider use of shared services for back office functions.

It is true that reference costs lie behind the ATI, but it is hardly news, as Carter’s first report made this perfectly clear. And discredited? Few in finance would champion the detailed accuracy of reference costs and the last audit found material inaccuracies in half of a sample.

But no-one is claiming absolute accuracy. As Lord Carter told the HFMA conference in December, the numbers (in the ATI and savings targets) may not be spot on, but they are good enough to provide reliable indications. And they should help organisations to ask questions – and perhaps help them to prioritise where to look for opportunities.

Anecdotal feedback from the 32 trusts supporting Carter’s work is positive. They see value in the work and welcome any tools that might help them in their endeavours to improve productivity. So, for example, the requirement for trusts to publish their receipts on a monthly basis for the top 100 items, such as bandages and rubber gloves, has to help NHS bodies avoid overpaying. Procurement – and taking advantage of the service’s collective buying power – is far from straightforward but few would argue that the NHS is already delivering optimum value in this area.

More data, benchmarks and greater transparency have to make sense. Boards should see this as helpful even if subsequent local discussions confirm local costs as appropriate.

To date, Carter has all been about the power of data. ‘Compare, challenge, explain, copy or change’ appears to be the mantra. The imposition of crude one-size-fits all caps or mandatory service models for support functions would appear to be out of step with this approach – although it will be interesting to see the tone of the final report.

The last question around Carter has to be capacity for delivery. There will inevitably have to be a process of prioritisation, especially as support services such as finance have a huge role in supporting the broader transformation of care models. The data provided by Carter should help in this process, giving local managers the information they need to isolate their best opportunities to deliver better value.

Can Carter deliver its £5bn savings target? Many would say much of that figure will get lost in the translation of theoretical potential into practice. But if it really leads to more data shared across the service and better understanding of relative costs and spending, it has to be a step in the right direction.